2026 marked Medicare Part D’s 20th anniversary. Congress took about 40 years to enact this coverage, which is not meant to benefit seniors. Rather it is a scam to enrich private insurance companies.
Part D is the so-called prescription drug program attached to Medicare. I say so-called because it isn’t actually a Medicare benefit. While Medicare rules govern the program, it is essentially fee based coverage provided by private insurance companies. Medicare simply approves the insurance companies, which can be limited and vary state by state.
Since Part D’s inception insurance companies have lobbied congress to make sure they are included. Insurance companies made sure they are wedged into the plan since there is a significant penalty for those signing up for Medicare at age 65 who opt not to sign up for Part D, even though they don’t need it.
Currently Part D has $2,100 out-of-pocket spending limit that includes deductibles, copayments and coinsurance for covered drugs in your stand-alone Part D plan or one folded into Medicare Advantage, you won’t pay any more for your prescriptions for the remainder of the year.
It is left up to the individual to decipher the plans offered by the private insurance companies annually. The alternative is staying with one company and absorbing any premium increases. A good example is the notice my wife and I received from Humana, the company we selected for 2026 coverage solely based on the monthly premium. The monthly premium will go from $4.70/month to $18.30/month. The deductible will go from $615 annually to $700 annually. Since neither one of us even reaches the annual deductible or out-of-pocket limit we are paying for coverage just to avoid the penalties for not having a plan if our prescription drugs ever increase. We are paying the bulk of the cost for our prescription drugs out of pocket.
It does take some work annually to review the private insurance plans offered. In most states those who need extra help wading through the plans can get help offered by state agencies. No matter the plan, insurance companies will make sure they get their pound of flesh out of seniors.